目的：重大精神病患有高於一般人之死亡率；有鑑於國內雙相情感障礙症（bipolar disorder以下簡稱躁鬱症）之中年病患共發慢性生理疾病或病程中有過自殺史的比例均達50％以上，由於自殺或生理疾病與死亡息息相關，因此本研究加以探討躁鬱症病患死亡之有關特徵以及危險因子。方法：就1985年至1996年間於臺北市立療養院之所有急性住院病患，經病歷回溯確定診斷為DSM-IV之躁鬱症者為對象。以身分證字號與衛生署1985-1996年之死亡檔加以連結，找出目前已死亡個案；再依死亡個案之年齡（±2歲）、性別、住院日期（±3年）為條件，挑選曾於該院急性住院但目前仍存活之躁鬱症患者為存活對照組，就所有醫療記錄收集研究相關之變項加以分析。結果：共收集目前死亡個案125位為研究組（女性65位、男性60位），自然死亡者64位（51.2%）、確定自殺死亡者43位（34.4％）；由於其中8位無適當存活對照組，故共117位為存活對照組（女性60位、男性57位）。躁鬱症最主要死因為自殺，確定自殺死亡者58.1%以非立即死亡的方法自殺；首要自然死因是心臟疾病。死亡個案最後急性住院之空腹血醣明顯高於存活對照組（P<0.025）、B型肝炎病毒帶原率（16.8%）亦明顯高於存活對照組（5.9%）（p<0.01）。多變項分析結果顯示與死亡相關之預測因子為：一級血親有自殺史、鋰鹽治療少於3年、有過以致命性方法企圖自殺以及初中教育程度為死亡之危險因子，然而「首次發病時合併有情緒一致之精神病徵」此變項為死亡之保護因子。結論：躁鬱症之主要死因迴異於同年齡層之國人，自殺以及心臟╱循環系統疾病最值得注意。低社經階層之初中教育程度者以及首次發病無合併情緒一致之精神病徵者可視為提早死亡的高危險群；空腹血醣高乃與躁鬱症的死亡有關連之生物性危險因子。B型肝炎病毒帶原率於躁鬱症存活個案是否偏低值得再加以探討；提早接受治療、維持良好治療配合度以及自殺的預防均能降低躁鬱症病患死亡之危險。

　　　　　Objective: High mortality in psychiatric patients has been well reported. Our prior work revealed that approximately half of middle-aged patients with bipolar disorder have concurrent chronic somatic illness or past history of suicide attempts. Death is the worst outcome of any disease and is related to suicide and physical problems. The aims of this study were to explore the characteristics and predictors for mortality in bipolar disorder patients. Methods: The medical records of all acute in-patients with bipolar disorder (DSM-IV) admitted to the Taipei City Psychiatric Center (TCPC) from January 1, 1985 to December 31, 1996 were reviewed. Mortality was studied through record linkage by matching national identity numbers with computerized data files from the Department of Health, Death Certification System in Taiwan issued through 1996. According to each deceased individual, age-and sex-matched bipolar patients who survived and who were once admitted to TCPC within a±3-year period were chosen as controls. Results: One hundred and twenty-five 65female and 60 male) patients with bipolar disorder died within the 12-year observation period. Sixty-four patients (51.2%) definitely died from natural causes and 43 (34.4%) definitely died as a result of suicide. One hundred and seventeen survivors with bipolar disorder were eligible as living controls. The principal cause of mortality in bipolar disorder was suicide, mainly using non-violent methods. The principal natural cause of mortality was cardiovascular diseases. The rate of hepatitis B virus carriers (HBV) was significantly higher in the deceased group (16.8%) than in the living controls (5.9%) (p<0.01). Additionally, the fasting blood sugar level of the deceased group was significantly higher than that of the living controls (p<0.025). Multivariate analysis showed the predictors of mortality including: a history of suicide in first-degree relatives, less-than-3 years of lithium treatment, a prior suicide attempt with lethal methods, a carrier of hepatitis B virus, and a 9-year educational level. However, onset with mood-con-gruent psychotic features was a protective factor against mortality in bipolar disorder. Conclusion: The principal causes of mortality in bipolar disorder differ from those of the general population. The risks of death from suicide and cardiovascular diseases are remarkably increased in patients with bipolar disorder. Low educational level and onset without mood-congruent psychotic features can identify the high-risk group for premature death. Higher fasting blood sugar levels and HBV carriers are closely related to mortality in bipolar disorder patients. Promoting compliance of medication, and suicide evaluation and prevention can reduce mortality in bipolar disorder patients.